Intrauterine Device (IUD)

The IUD (or Intrauterine Device) is a reliable long-term method of birth control, though it’s not right for every woman.

WHAT IS IT?
IUD stands for “Intrauterine Device.” An IUD is a small T-shaped object made of copper and plastic. A health care provider inserts the IUD into the uterus, where it can remain for 5-10 years, depending on the brand. We don’t know exactly how IUDs prevent pregnancy, but we do know that the presence of the IUD makes the uterine environment spermicidal (sperm can’t live there). Some IUDs also contain the hormone progesterone and release it into the body over time, which causes changes in the cervical mucus so sperm cannot move through.

WHERE CAN I GET IT?
A woman who wants to use an IUD will need to speak with her health care provider, who will determine whether or not she is a good candidate for the method. This determination will be based on her health history and her sexual history. IUD users should be at low risk for STIs, because if a woman with an IUD in place contracts an infection, the presence of the IUD can cause complications that could leave her unable to have children. For this reason, the best candidate for an IUD is a woman who is in a long-term (meaning that the couple has been together for some time and plans to stay together) mutually monogamous (meaning that the people in the relationship are only having sex with one another) relationship and who has already had children or doesn’t want any. Women who have never been pregnant are more likely to naturally expel their IUDs.

Women who use IUDs should have easy access to their health care provider in case complications do result.

HOW DO I USE IT?
Only a health care provider can insert or remove an IUD. The clinician uses a special device to perform these procedures. Some women find that the insertion and removal procedures causes discomfort, but once the IUD is in place, the woman should not be able to feel it, though it may take a few days, weeks, or months for a woman to be completely comfortable.

There are two strings attached to the bottom of the IUD. These strings are about the thickness of sewing thread and hang out of the uterus and down through the cervix, about an inch into the top of the vagina. A woman using an IUD should regularly check the strings to make sure that the IUD is still properly in place. In most cases, neither the woman nor her partner will be able to feel the strings during intercourse. The health care provider should give the woman detailed instructions on how to check her IUD.

It is possible for expulsion of the IUD to occur. This is most likely to happen during menstruation, so it’s important to watch the menstrual fluid for the IUD.

When a woman is ready to have her IUD removed – because it’s time for a new one, because she wants to get pregnant, or because she no longer wishes to use the IUD as her method – she must see her health care provider. She should never, ever try to remove an IUD herself.

WHAT ARE THE POSSIBLE SIDE EFFECTS?
Many women use IUDs with few complications or side effects. The most common are:

o Heavier periods with more cramping (women who naturally have heavy, uncomfortable periods might want to use a method other than an IUD, as the device can make periods worse)
o Some discomfort while getting used to having the IUD in place

There are some potentially serious side effects that could occur as a result of IUD use, including infection, uterine puncture (when the IUD pokes a hole in the uterus), and Pelvic Inflammatory Disease (PID). While these side effects are rare, it is important for all women to be aware of the symptoms:

o Increased or bad-smelling discharge from the vagina
o Missed periods
o Pain (especially if there was no pain before)
o Fever
o Bleeding from the vagina between periods

If a woman has an IUD in place and experiences any of these symptoms, she should contact her health care provider immediately.

HOW WELL DOES IT WORK?
IUDs are 98-99% effective in the prevention of pregnancy. Because they are inserted and removed by a health care provider, there is no opportunity for user error, which can decrease the effectiveness of any method. IUDs do not provide any protection against Sexually Transmitted Infections (STIs) or HIV.

WHAT ARE SOME OF THE ADVANTAGES AND DISADVANTAGES OF THE METHOD?
Advantages:
o If the IUD is left in place for a long time, it is a very cost-effective method
o Since it is inserted by a health care provider, there is no opportunity for user error to decrease the effectiveness of the method
o The IUD is in place all the time, so there is no need to interrupt sexual activity to use it

Disadvantages:
o Not every woman can safely or comfortably use an IUD
o High initial cost
o Can cause menstrual discomfort
o May lead to complications if a woman contracts an STI with an IUD in place

HOW MUCH DOES IT COST?
The cost of an IUD varies by type and health care provider. In most cases, a woman can expect to pay $200-$600 for the IUD and the insertion of it. The cost of removal may be included in the original cost or it may be an additional $100-$200. If a woman goes to a reproductive health clinic for her IUD, the cost may be lower. At the Family Planning Association, we charge $200 for an IUD insertion, or less, depending on what the client can afford. Some health insurance will cover all or part of the cost of an IUD.